Pig Pancreas Anatomy: Implications for Pancreas Procurement, Preservation, and Islet Isolation

Abstract

Background Islet transplantation is emerging as a treatment option for selected patients with type 1 diabetes. The limited human islet supply from cadavers and poor islet yield and quality remain substantial impediments to progress in the field. Use of porcine islets holds great promise for large-scale application of islet transplantation. Consistent isolation of porcine islets is dependent on advances in pancreas procurement and preservation, and islet isolation requiring detailed knowledge of the porcine pancreatic anatomy. The primary aim of this study was to describe the vascular and ductal anatomy of the porcine pancreas in order to guide and improve organ preservation and enzyme perfusion. Methods Pancreata were removed by en bloc viscerectomy from 65 female Landrace pigs. Results 15% of organs exhibited inconsistent vascular branching from the celiac trunk. All organs had uniform patterns of branching at the superior mesenteric artery. The superior and inferior mesenteric veins (IMV) merged to become the portal vein in all but one case in which the IMV drained into the splenic vein. 97% of pancreata had three lobes: duodenal (DL), connecting (CL), and splenic (SL); 39% demonstrated ductal communication between the CL and the other two lobes; 50% had ductal communication only between the CL and DL; and 11% presented other types of ductal delineation. Conclusions Accounting for the variations in vascular and ductal anatomy, as detailed in this study, will facilitate development of protocols for preservation, optimal enzyme administration, and pancreas distention and digestion, and ultimately lead to substantial improvements in isolation outcomes.

Partial dorsal agenesis accompanied with circumportal pancreas in a donor for islet transplantation

“…Circumportal pancreas is a rare and not well recognized variant, although entirely normal and expected in pigs, 7 where the uncinate process of the pancreas extends behind the portal vein and fuses to the posterior aspect of the body. A variety of terms have been used to describe this variant, including periportal annular pancreas, 8 circumportal pancreas, 9 and portal annular pancreas.…”

Long-term evolution of acinar-to-ductal metaplasia and β-cell mass after radiofrequency-assisted transection of the pancreas in a controlled large animal model

“…Original illustration of a normal anatomy of the porcine pancreas and the surgical procedure after the first section of the pancreas according to the anatomy described by Ferrer et al [18]. The "splenic" lobe (SL), corresponding to the tail and body in the human pancreas, is attached to the spleen.…”

“…In order to achieve complete obstruction of the distal part (body and tail) of the pancreatic gland was transected including the main pancreatic duct which was severed over and below the portal vein according to the previous study on pancreas anatomy ( Figure 1) [18]. The pancreas was mobilized and slightly tractioned to ensure a 5-mm minimum safe distance between RFAT site and major peripancreatic vessels and surrounding viscera to avoid unexpected injuries.…”

“…Many of these anatomical difficulties can be overcome with a large pancreas model, such as the pig model, in which the pancreas is large and clearly defined [18], especially if the closed proximal part (duodenal lobe) is preserved to avoid a difficult-to-treat steatorrhea [19]. However, in the pig model a larger amount of tissue must be severed and hence PDL may not be able to avoid a pancreatic fistula or to efficiently occlude the main pancreatic duct in the mid pancreas.…”

Islet Isolation from Juvenile Porcine Pancreas after 24-h Hypothermic Machine Perfusion Preservation

“…Moreover, the age, and even the strain, guaranteed 24-h continuous perfusion. of the donor pig has been documented by several groups Surgical Model to markedly influence the islet isolation process, with young, so-called market size pigs (<6 months old) provUntil recently, the anatomy of the pig pancreas was not well documented (11,36,39). Physiologically and ing to be particularly difficult as a source of transplantable islets (7,10,50).…”